CROI 2014: HIV self-testing yields promise in first year of Malawi rollout

BOSTON, MASS – In the first year that residents in Blantyre, Malawi were offered the option to test for HIV through home, or self-test kits, available through community health worker distribution, vending machines, over the counter in pharmacies and in grocery stores, 76 percent of those given the opportunity to self test took it, and 75 percent of those who tested HIV positive were successfully linked to care, according to a study reported at CROI on Thursday.

Malawi is the only country in Africa to implement and evaluate home testing for an entire community and may be the only one in the world. With 46,000 new HIV infections in 2011 and 910,000 people living with HIV, addressing a testing gap that leaves 66 percent of the population unaware of their HIV status is critical to controlling the epidemic in this poor country.

Augustine Choko from the Malawi Liverpool Wellcome Trust Clinical Research Programme offered details on the results to date including feedback from participants – 89 percent of whom responded to a questionnaire. Before consenting to use the self-test, only 25 percent of respondents reported receiving an HIV test in the previous year in this part of the country with an HIV prevalence of 18.5 percent. Forty-four percent of the participants were first time testers. More than 50 percent of women between the ages of 16 to 19 years old tested within 2 months with almost 100 percent testing by the end of the 12-month period. High rates of linkage to care followed, among those participants willing to disclose their status to the community lay counselors who distributed the tests. Ninety–eight percent of survey responders said they would recommend this form of private testing to their family members and friends. On the negative side, 3.7 percent of men and 2.2 percent of women felt “forced to test”, primarily by their partners and several cases of gender-based violence were reported.